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Medical Management of Diabetes: A 2016 Update

Your patient is one of the majority of US patients with diabetes who are not able to achieve their target A1c goals. What do you do? Dr. Neil Skolnik and colleagues offer an overview of your treatment options with an emphasis on newer medications for diabetes. They will discuss barriers to achieving A1c goals, criteria for individualizing treatment for each patient, and how to decide which medication to choose next when your patients are not reaching their target. They will address the ADA’s evaluation of several drug classes’ efficacy, hypoglycemia risk, weight considerations, side effects, and cost, so that you are armed with a comprehensive understanding of how to best treat each of your patients.

Neil Skolnik, MD
Professor of Family and Community Medicine, Temple University School of Medicine, Associate Director, Family Medicine Residency Program, Abington Jefferson Health
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Latest Comments
"In this day and time when hospitals are confronted with penalties for readmission of CHF pts., it is nice to know that this class of drugs have shown to reduce hospitalizations for CHF.  As PCP we all strive to keep our pts. healthy and the fact that SGLT-2 inhibitors decrease all-cause mortality, CV mortality this is one drug that provides a great benefit to our T2DM pts.  The potential mechanisms of renal protection which include a reduction in hyperfiltration, albuminuria, glomerular B/P, systemic B/P, arterial stiffness, HbA1c, weight and inflammation the benefits outweigh the risks.  In addition, the benefits of decrease in intravascular volume, nephropathy, progression to macroalbuminuria, risk of doubling serum creatinine and the need for renal replacement therapy all support the fact that this is a drug of choice for most diabetics.  Again, the renal protection SGLT-2 inhibitors offer for pts with cardiovascular disease and the fact that CV risks are decreased considerably with SGLT-2 inhibitors it is unfortunate that this class of agents are not covered by all insurance companies policies. 

To your knowledge even though it is off label, are providers using SGLT-2I for type 1 diabetic having any success?

Are other countries prescribing SGLT-2I for T1DMs?

Thanks,

Valerie Ting, FNP-BC"
Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
186 Comments
"GLP-1RAs seem to be one of most promising new therapies available today.  With reduced hypoglycemia, weight, B/P and CV mortality, GLP-1 RAs are now being prescribed more and more in our office.  I guess the biggest drawback on prescribing these drugs are the GI side effects and cost restrictions on payment sources.     

QUESTION:

How often are GLP1-RA found to be the contributing factor which has been directed linked to the causation of acute pancreatitis?

Thanks,

Valerie Ting, FNP-BC"
Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
197 Comments
 

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